HALCyon Healthy Ageing across the Life Course

Abstract

HALCyon brings together an interdisciplinary group of scientists working on nine UK cohort studies to understand three aspects of healthy ageing: physical and cognitive capability (the ability to undertake the physical and mental tasks of everyday living), psychological and social wellbeing (how people feel and how they function in terms of relationships and social activities), and the biology of ageing, including cortisol (one of the body's stress hormones), telomere length (the cell's natural clock that tells the body how old it is) and genetic factors.

The eight projects will investigate how individual factors such as early development, lifetime health, personality and nutrition, and characteristics of areas in which study members have lived influence these indicators of healthy ageing. These factors may explain why some older people live fulfilled and active lives and why differences exist between men and women, or between social groups. Some cohort members will be interviewed to find out how they understand their life history and experiences and their response to ageing.

Interactions between the scientists and experts in policy, practice and user involvement will ensure that the new knowledge gained will improve the lives of older people.

HALCyon has used interdisciplinary and integrative research to better understand how healthy ageing is affected by social, psychological and biological factors operating across the whole of life. This involved the utilisation of existing and newly collected data from 9 UK cohort studies. These cohorts included over 30,000 men and women born between 1918 and 1958, and who were aged 50 and older at the start of the programme.

The findings from the HALCyon research programme suggest that a broad set of modifiable risk factors across life already identified for chronic diseases may also affect the chance of optimising capability and wellbeing in later life.

In the 46 papers produced by the HALCyon collaboration we have reported on a wide range of findings from our investigations into the factors across life associated with healthy ageing across cohorts including: robust evidence of the influence of childhood socioeconomic circumstances (at both the individual and area level) and lifetime body size on later life physical capability, and of early cognition and education on later life cognition; some evidence that the ability of the HPA axis to mount a good stress induced response may protect physical capability; no clear or consistent evidence of associations of genetic factors and telomere length with capability; limited evidence of associations between early life factors and anxiety and depression in later life but clear evidence of influences of poor health and disability on these psychological outcomes and; evidence of a modest association between childhood cognitive ability and wellbeing in later life. The team have: identified research priorities by showing how few studies have investigated the dynamic relationship between physical and cognitive capability; and started to fill research gaps by carrying out cross cohort studies showing modest associations between capability and subsequent wellbeing.

Specific examples include:• a systematic review and meta-analysis of all published data which showed that, after adjusting for age, those who have weaker grip strength, slower walking speed, greater difficulty getting up from a chair and poorer standing balance performance are more likely to die sooner and develop health problems than people who perform well in these tests. (Cooper et al., British Medical Journal 2010 and Cooper et al., Age and Ageing 2011).• analyses of the MRC National Survey of Health and Development which showed that neuroticism and extraversion in adolescence are associated with positive mental wellbeing and life satisfaction at age 60-64 (Gale et al., Journal of Research in Personality 2013).• an investigation into how to deal with inconsistencies in census area socioeconomic measures over time, changes in reporting unit size to which measures apply, and secular social changes over time (Murray et al., Health and Place 2012). • the combining of results from a systematic review and meta-analysis of published data with new analyses undertaken across the HALCyon cohorts to formally re-evaluate the claims that the ACTN3 genotype influences sporting performance. The systematic review found evidence of an effect of this genotype on power/sprint athletic status in Europeans but that there was no evidence of an effect of this genotype on physical capability in the general population (Alfred et al., Human Mutation 2011).• meta-analyses using data from six cohorts (four HALCyon cohorts plus Whitehall II and LASA), found that a more dynamic HPA axis, best measured by greater diurnal decline, was associated with faster walking speed and better chair rise times among participants aged 50-92y. However, there was no strong evidence of associations with grip strength or standing balance (Gardner et al,.Psychoneuroendocrinology 2013).• qualitative interviews with subsamples of participants from the Hertfordshire Cohort Study and MRC National Survey of Health and Development which highlighted a) that there are some differences in the way older people view aspects of ageing by capability, b) that although advantages of ageing are widely perceived, physical decline and associated health concerns are recurring themes, c) the importance of the partner's health during ageing as well as the health of the participant (Parsons et al., Ageing and Society 2012).• Although assessment of telomere length is used diagnostically in some well defined clinical areas, the use of telomere length to aid diagnosis or risk assessment in the general population is premature (von Zglinicki, British Medical Journal 2012).

HALCyon has played a major role in advancing understanding of the requirements for the harmonisation of data both between and within cohorts, developing approaches to the coordinated analyses of these data across cohorts and carrying out sensitivity analyses and highlighting the challenges.

HALCyon researchers joined forces with researchers on the Integrative Analysis of Longitudinal Studies of Aging (IALSA) network to secure funding from the Canadian Institute of Health Research to support a Post-Doctoral Researcher and have secured further funding from the US National Institutes of Health to continue the HALCyon network.

Exploitation Route

There are substantial challenges of translating research findings from observational studies, such as those produced by HALCyon, into practice or policy-relevant messages for healthy ageing. However, following the completion of the HALCyon programme further investigation is now warranted to determine how the findings can be translated into practice so that the programme has not only a scientific but also an economic and societal impact. We are currently building up connections with experts in social policy at LSE to do this. HALCyon will continue through the Integrative Analysis of Longitudinal Studies of Aging and Dementia (IALSA) research network.

The findings of the HALCyon programme have reached further than the academic community. A summary brochure was designed to accompany the 'A life course approach to Healthy Ageing' book produced for an academic audience and is being disseminated in print and online to a wider, more general audience with the help of our knowledge transfer partner, Age UK. This brochure considers the ideas presented in the book about how we might delay or slow down the progressive, generalised impairment of function that occurs at the individual, body system and cellular levels, as people grow older. It also considers the determinants of wellbeing in older people, including personal fulfilment, positive emotions and lifelong social relationships
HALCyon developed ways of conceptualising, defining and measuring healthy ageing in order to investigate lifetime factors that impact on this. What the HALCyon team learnt during the programme (which was written up in the OUP book 'A life course approach to healthy ageing' and in the accompanying brochure) has driven future research directions at the MRC Unit for Lifelong Health and Ageing (LHA) which led HALCyon, and in new consortia, such as CLOSER, IALSA, and various European collaborations, that the HALCyon team joined forces with to maintain research funding for this type of research. One of the 5-year objectives for LHA is to develop more links with policymakers and researchers involved in policy research on ageing for the government; for example, we have established an evolving and growing link with experts in social policy at LSE. Through CLOSER we are developing more links with policy makers interested in healthy ageing, and have contributed an evidence summary on physical capability (one of the main components of healthy ageing) for their new website, aimed at a wide audience, including policy makers; and we also plan to feature 'ageing' as a special CLOSER topic in Autumn 2015. Members of the HALCyon team are providing a growing number of training and capacity building events, through CLOSER and IALSA, and through invitations to lead a Wellcome Trust Scientific conference and a themed issue of the International Journal of Epidemiology on the topic of 'A life course approach to ageing', both in 2015, and through our participation in an MRC review of healthy ageing indicators that will offer guidance to the field. We also took our message to a large European meeting in Montpelier in 2014 that was attended by several EU policymakers and will present again at an upcoming meeting in Poland in 2015. We have also incorporated measurements of healthy ageing into a large scale Russian survey. HALCyon also provided a model for growing collaborations and networks in the field of cross cohort and ageing research, including data sharing protocols and data harmonisation protocols.
Policy relevant messages from the HALCyon programme are also being disseminated via the European Research Edition of International Innovation which is a printed open access research report focused on communicating healthcare research worldwide and helping researchers connect and build projects and partnerships between different regions and show the impact of their research on the wider health community.
Overall HALCyon with its cross cohort research portfolio, has contributed significantly to the growing emphasis on functional change in UK ageing research, both aetiological and policy driven, which integrates rather than separates research on specific age-related diseases. In that sense it has had a strong cultural as well as a societal impact.

First Year Of Impact

2013

Sector

Healthcare

Impact Types

Cultural,Societal

Title

HALCyon data sets and meta data

Description

One of the main aims of HALCyon was to perform comparable analyses across 9 British cohort studies which tested the inter-relationships between: physical and cognitive capability; social and psychological wellbeing and; underlying biological markers of ageing. Another main aim was to test the associations of factors across life with each of these three sets of measures. In the majority of cases, this involved harmonising secondary data from the 9 participating studies which had been provided to the HALCyon study team by cohort PIs. For details of how to access the most up to date versions of these secondary data please contact the MRC Unit for Lifelong Health and Ageing at UCL, the relevant cohort leads or where available download these data from UK Data Service ReShare (for ELSA and 1958 birth cohort).
The following documentation is freely available via UK Data Service ReShare or the HALCyon data documentation page
(1) lists of the comparable variables available in each cohort for topics of relevance to HALCyon;
(2) Stata syntax which was used to clean and recode data for use in analyses that were comparable across cohorts.
The NDA grant for HALCyon also included funds to
- collect comparable data on wellbeing in: Hertfordshire Cohort Study (HCS); Caerphilly Prospective Study (CaPS); Aberdeen Birth Cohort 1936 (ABC1936)
See for example: Cooper R et al. AGE 2014;36:445-456
- measure telomere length using existing blood samples in: Lothian Birth Cohort 1921 (LBC1921); CaPS; Hertfordshire Ageing study (HAS); MRC National Survey of Health and Development
See for example: Gardner M et al. PLoS One 2013;8(7):e69526
- perform cortisol assays using existing saliva samples in: CaPS and NSHD
See for example: Gardner M et al. Psychoneuroendocrinology 2013;38:40-49
- undertake qualitative interviews with HCS and NSHD participants (30 in each study)
See for example: The content of the interview topic guide, the sampling strategy and the characteristics of the sample achieved are described in a Centre for Longitudinal Studies working paper (2011/5), by Jane Elliott et al, October 2011

Presentation at 8th World Congress on Developmental Origins of Health and Disease, Singapore, 17-20th November 2013

Year(s) Of Engagement Activity

2013

Description

A life course approach to ageing: recent findings from the MRC National Survey of Health and Development and other UK cohort studies

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Primary Audience

Results and Impact

Talk at Liverpool University

Year(s) Of Engagement Activity

2013

Description

A life course approach to physical capability

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Primary Audience

Results and Impact

HALCyon symposium

Year(s) Of Engagement Activity

2013

Description

A life course approach to physical capability: What have we found in HALCyon and where will we go from here?

Form Of Engagement Activity

Participation in an activity, workshop or similar

Part Of Official Scheme?

No

Primary Audience

Results and Impact

Lecture at a symposium

Year(s) Of Engagement Activity

Description

A life course approach to physical capability: What have we found in HALCyon and where will we go from here?

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Primary Audience

Results and Impact

A life course approach to physical capability: What have we found in HALCyon and where will we go from here? CLOSER Symposium: Functioning well in later life:What is the evidence from longitudinal studies? London 15th January 2013.

Year(s) Of Engagement Activity

2013

Description

A life course approach to physical capability: findings from the HALCyon research programme.

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Primary Audience

Results and Impact

presentation at conference

Year(s) Of Engagement Activity

2013

Description

A life course approach to psychological and social wellbeing

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Primary Audience

Results and Impact

HALCyon symposium

Year(s) Of Engagement Activity

2013

Description

Ageing Mechanisms and Biomarker Research. Key note lecture

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Primary Audience

Results and Impact

key note lecture

Year(s) Of Engagement Activity

2013

Description

Ageing mechanisms and biomarker research

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Primary Audience

Results and Impact

Keynote lecture.

Year(s) Of Engagement Activity

2010

Description

An epidemiological perspective on biological models of ageing

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Primary Audience

Results and Impact

Presentation

Year(s) Of Engagement Activity

2013

Description

Associations of area deprivation over the life course and physical capability in mid-life: findings from the 1946 British Birth Cohort

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Primary Audience

Results and Impact

Presentation

Year(s) Of Engagement Activity

2013

Description

Body size and physical capability.

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Primary Audience

Results and Impact

presentation

Year(s) Of Engagement Activity

2013

Description

Can we intervene to promote capability and wellbeing?

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Primary Audience

Results and Impact

HALCyon symposium

Year(s) Of Engagement Activity

2013

Description

Can we intervene to promote capability and wellbeing?

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Primary Audience

Results and Impact

presentation

Year(s) Of Engagement Activity

2013

Description

Case based and variable based approaches to understanding healthy ageing

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Primary Audience

Results and Impact

Presentation at University of Southampton, 14th June 2011.

Year(s) Of Engagement Activity

2011

Description

Census and Society

Form Of Engagement Activity

Participation in an activity, workshop or similar

Part Of Official Scheme?

Yes

Geographic Reach

International

Primary Audience

Public/other audiences

Results and Impact

Murray ET. Map of the average time in which cohort members could balance with eyes closed at age 53 years, based on the percent of people in the local government area that worked in low social class occupations when they were 4 years old. Exhibit piece at the British Library's 'Census and Society: Why Everyone Counts', 7th March - 29th May, 2011.

http://www.bl.uk/whatson/exhibitions/census/census.html. Map of the average time in which cohort members could balance with eyes closed at age 53 years, based on the percent of people in the local government area that worked in low social class occupations when they were 4 years old. Exhibit piece at the British Library's 'Census and Society: Why Everyone Counts', 7th March - 29th May, 2011.

http://www.bl.uk/whatson/exhibitions/census/census.html.

Map of the average time in which cohort members could balance with eyes closed at age 53 years, based on the percent of people in the local government area that worked in low social class occupations when they were 4 years old. Exhibit piece at the Britis

Examples of data harmonisation and cross-cohort work with discussion of the challenges and implications for analysis within and across cohorts.

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Primary Audience

Results and Impact

presentation

Year(s) Of Engagement Activity

2013

Description

Exhibit piece - map of the average time in which cohort members could balance with eyes closed at age 53 years

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Geographic Reach

International

Primary Audience

Professional Practitioners

Results and Impact

Map of the average time in which cohort members could balance with eyes closed at age 53 years, based on the percent of people in the local government area that worked in low social class occupations when they were 4 years old. Exhibit piece at the British Library's 'Census and Society: Why Everyone Counts' Exhibit piece at the British Library's 'Census and Society: Why Everyone Counts'

http://www.bl.uk/whatson/exhibitions/census/census.html.

Exhibit piece at the British Library's 'Census and Society: Why Everyone Counts'

A plain english brochure was created which summarised the main findings from the HALCyon research programme. It has been disseminated to study members, on our website and the New Dynamics of Ageing website and at conferences.

Increased awareness of the findings from the HALCyon programme and the cohorts that were used within this research programme

Year(s) Of Engagement Activity

2014

Description

HALCYon book launch

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Geographic Reach

Regional

Primary Audience

Other academic audiences (collaborators, peers etc.)

Results and Impact

A book launch was arranged to promote the findings from the HALCyon research programme

Shared knowledge of the HALCyon findings which were published in a book 'A life course approach to healthy ageing'.

Year(s) Of Engagement Activity

2014

Description

HALCyon Symposium at Oxford Ageing Conference

Form Of Engagement Activity

Participation in an activity, workshop or similar

Part Of Official Scheme?

No

Primary Audience

Results and Impact

HALCyon Symposium at Oxford Ageing Conference

Year(s) Of Engagement Activity

Description

HALCyon: Healthy Ageing across the Life Course

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Primary Audience

Results and Impact

Health Development Forum Showcase and networking event

Year(s) Of Engagement Activity

2014

Description

Health Ageing across the Life Course: Findings from the HALCyon collaborative research programme.

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Primary Audience

Results and Impact

Presentation at Centre Day: International Centre for Life Course Studies in Society and Health. London, January 2011.

Year(s) Of Engagement Activity

2013

Description

Health ageing across the life course : findings from the HALCyon collaborative research programme

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Primary Audience

Results and Impact

Centre Day: International Centre for Life Course Studies in Society and Health.

Year(s) Of Engagement Activity

2012

Description

How good is blood cell telomere length as a biomarker of ageing? Berzelius Symposium Telomere length in health and disease

Background: Evidence suggests that measures of physical capability may be predictive of subsequent disability, health and mortality, but the results from existing published studies have not been synthesised. Objectives: To review published literature examining the associations between physical capability and subsequent all-cause mortality. Design: Systematic review and meta-analysis. Sources: Medline (from 1950 to 2008/05), EMBASE (from 1980 to 2008/02) and manual searches of the reference lists of eligible papers. Included Studies: Any study examining the association between at least one of the specified measures of physical capability (grip strength, chair rises, standing balance, walking speed/time) and mortality in a population who were healthy and community-dwelling at baseline. Results: Of 2240 unique records screened, 20 papers met the inclusion criteria of the review. An additional 3 papers were identified from reference lists. Within the 23 papers, there were 17 published analyses of grip strength, 9 of walking time/speed, 2 of standing balance and 1 of chair rises. The mean age of participants ranged from 36 to 80 y but the majority of study populations were aged 60 y and above. Of the papers investigating the association between grip strength and mortality, 6 presented Hazard Ratios for a unit change in grip strength with basic adjustments (total n?=?10?171, deaths?=?4267). The pooled Hazard Ratio for mortality per 5 kg increase in grip strength, from a random effects meta-analysis, was 0.90 (95% CI 0.87 to 0.93). Heterogeneity between studies (I2?=?65.2%) was largely explained by a single study which had weaker results. The pooled HR when this study was removed was 0.89 (0.86 to 0.92) (I2?=?25.7%). Other papers, where comparisons between categories of grip strength had been performed, also generally found weaker grip strength to be associated with higher rates of mortality but these analyses were too heterogeneous to be combined using meta-analysis. Due to differences in the ways in which walking speed had been measured and analysed it was not possible to perform meta-analyses of these data, but the results from all 9 studies showed that slower walking speed/longer walking time was significantly associated with increased mortality risk. Conclusions: This review demonstrates that grip strength and walking time/speed are useful markers of subsequent mortality risk in community-dwelling populations. The underlying explanations of these associations needs to be elucidated and further research is necessary to assess whether other measures of physical capability, including chair rises and balance, have similar predictive value.

Physical capability and subsequent mortality : a systematic review and meta-analysis of published data

Form Of Engagement Activity

A talk or presentation

Part Of Official Scheme?

No

Primary Audience

Results and Impact

Background: Evidence suggests that measures of physical capability may be predictive of subsequent disability, health and mortality, but the results from existing published studies have not been synthesised.

Objectives: To review published literature examining the associations between physical capability and subsequent all-cause mortality.

Included Studies: Any study examining the association between at least one of the specified measures of physical capability (grip strength, chair rises, standing balance, walking speed/time) and mortality in a population who were healthy and community-dwelling at baseline.

Results: Of 2240 unique records screened, 20 papers met the inclusion criteria of the review. An additional 3 papers were identified from reference lists. Within the 23 papers, there were 17 published analyses of grip strength, 9 of walking time/speed, 2 of standing balance and 1 of chair rises. The mean age of participants ranged from 36 to 80 y but the majority of study populations were aged 60 y and above. Of the papers investigating the association between grip strength and mortality, 6 presented Hazard Ratios for a unit change in grip strength with basic adjustments (total n?=?10?171, deaths?=?4267). The pooled Hazard Ratio for mortality per 5 kg increase in grip strength, from a random effects meta-analysis, was 0.90 (95% CI 0.87 to 0.93). Heterogeneity between studies (I2?=?65.2%) was largely explained by a single study which had weaker results. The pooled HR when this study was removed was 0.89 (0.86 to 0.92) (I2?=?25.7%). Other papers, where comparisons between categories of grip strength had been performed, also generally found weaker grip strength to be associated with higher rates of mortality but these analyses were too heterogeneous to be combined using meta-analysis. Due to differences in the ways in which walking speed had been measured and analysed it was not possible to perform meta-analyses of these data, but the results from all 9 studies showed that slower walking speed/longer walking time was significantly associated with increased mortality risk.

Conclusions: This review demonstrates that grip strength and walking time/speed are useful markers of subsequent mortality risk in community-dwelling populations. The underlying explanations of these associations needs to be elucidated and further research is necessary to assess whether other measures of physical capability, including chair rises and balance, have similar predictive value.